The thyroid is a butterfly-shaped gland located in front of the neck and below the Adam’s apple. It is a part of the endocrine system that is responsible for coordinating every cellular process in the body and in making hormones that regulate metabolism. It calibrates just how much energy the body needs, how much fat to produce and how much muscles should be built. When the body encounters stressors from the external or internal environment, the thyroid gland will modulate its secretions to maintain homeostasis. 

It is important to recognize the common stressors in order to effectively manage them in your life or to eliminate them. 

  • Psychological stressors are emotional in nature. They may include grief, anxiety, anger, fear, hostility, and pessimistic outlook on life.
  • Physical insults such as surgery, injury, pain, and diabetes and autoimmune diseases.
  • Chemical exposure from environmental pollutants present in household and personal care products, food, air, water, and medications. Particularly, arsenic, cadmium, and mercury. 
  • Pathogenic infection of viral, bacterial, or fungal nature.
  • Acute situational stressors such as job stress or breakup of a relationship.
  • Mineral deficiencies- such as iodine and selenium.

There are also factors that impair the functions of thyroid hormones. They include:

  • Alcohol consumption
  • Cigarette smoking
  • Diabetes
  • Low progesterone
  • Growth hormone deficiency
  • Aging that accompanies decline in growth hormone
  • Obesity

There are four common disorders of the thyroid where that can be too much hormone (hyperthyroidism) or not enough (hypothyroidism). 

  • Hashimoto’s disease
  • Grave’s disease
  • Goiter
  • Thyroid nodules

Graves disease:

Graves’ disease is the most common cause of hyperthyroidism. Other causes may involve nodules on the thyroid or goiters. 

Signs and Symptoms include:

  • Sudden or significant weight loss
  • Restlessness
  • Nervousness
  • Racing Heart
  • Trouble sleeping
  • Muscle loss and weakness
  • Bulging eyes (in Graves Disease)

Hypothyroidism:

This is a condition when the thyroid gland is underactive and can’t produce enough of its hormones or is removed by surgery or damaged by radiation treatment. Hashimoto’s disease is the most common cause of hypothyroidism which primarily affects middle-aged women but can also occur in men, children, and women of any age. Hashimoto’s disease is an autoimmune disorder in which your immune system attacks your thyroid gland. If left untreated, an underactive thyroid gland can lead to goiter, heart problems, depression, loss of libido, slow mental functioning, and other more serious complications such as birth defects in babies born to women with hypothyroidism and myxedema. 

Signs and Symptoms include:

  • Fatigue and sluggishness
  • Low energy and stamina, especially in the evening
  • Constipation or irregular bowel habits
  • Unexplained weight gain 
  • Depression
  • Muscle weakness
  • Memory lapses
  • Enlargement of the tongue
  • Brittle nails
  • Hair loss
  • A puffy face
  • Pale, dry, thinning, itchy skin
  • Intolerance to cold
  • Joint pain and stiffness

It is important to note that thyroid-like symptoms may be present despite having normal thyroid hormone levels. It is estimated that 30 millions adults suffer from thyroid imbalance and as many as 60% of people with thyroid disease are not aware of it. 

Levels of key thyroid hormones can indicate whether there is a thyroid imbalance. These include:

  • TSH (Thyroid Stimulating Hormone) is produced by the pituitary gland and it acts on the thyroid gland to stimulate production of T4 hormone.  
  • Total T4 (Thyroxine) is an indicator of the thyroid gland’s ability to synthesize, process, and release T4 into the bloodstream.
  • Free T4(Thyroxine) is the predominant thyroid hormone that is converted to its active form, T3. 
  • Free T3 (Triiodothyronine) is the active thyroid hormone that regulates the metabolic activities of cells.
  • TPOab (Thyroid Peroxidase Antibodies. The presence of these antibodies indicates autoimmune thyroiditis and Hashimoto’s disease since thyroid peroxidase is an enzyme involved in thyroid hormone production. 
  • Tgbn (Thyroglobulin). This protein is rich in tyrosine, binds to iodine to form the building blocks of T3 and T4 hormones. High levels may indicate an iodine deficiency. Iodine is an essential mineral for healthy thyroid function.

Treatment of hypothyroidism includes thyroid supplementation with

  • T4 hormone such as Synthroid or levothyroxine is a synthetic version of T4 (thyroxin).
  • Glandular thyroid such as Armour Thyroid and Nature-Thyroid contains combinations of thyroxine/triiodothyronine (T4/T3) hormones in approximately 4:1 ratio of T4:T3. It is derived from porcine thyroid glands.
  • T3 hormone such as Cytomel or liothyronine is a synthetic version of T3 (triiodothyronine).
  • Custom T4:T3 dosages. This option may be desired for the following reasons.There are pharmacokinetic differences between T4 and T3. 
         1. The half-life of T4 is 9 days compared to the half-life of 18 hours for T3. 
               -> Every other day dosing for T4 
               -> Twice a day dosing for T3     
        2. T3 is three to four times more potent than T4. 
                -> T3 peak can be minimized by using 12-hour dosing intervals with slow-release capsules to mitigate the negative feedback loop of TSH suppression that occurs post dose. 

  • Commercial combinations of T4:T3 with glandular thyroid supplements delivers a 4:1 ratio of hormones. However, the body usually secretes T4:T3 in an 11:1 ratio.
  • The oral bioavailability of T4 is 0.8 compared to T3 which has an oral bioavailability of 0.95.

We can make custom dosages that deliver an 11:1 ratio using a commercial T4 product. We can also compound T4:T3 in a 13:06:1 ratio by taking into account oral bioavailability of each entity for truly precise dosing. 

Wells Pharmacy is committed to making personalized custom compounds of the highest quality. We are happy to assist in dosing recommendations.You may submit a question using our online form or by calling us at (909)949-6889.

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